CHP Retiree Advantage (HMO)

Capital Health Plan Retiree Advantage (HMO) is offered by some employers to their Medicare-eligible retirees and Medicare-eligible dependents of retirees allowing members to continue to participate in their employer-sponsored health plan after retirement and becoming Medicare eligible. To be eligible, your employer must offer Retiree Advantage and you must be entitled to Medicare Part A, enrolled in Medicare Part B, and live in the Capital Health Plan service area. Retiree Advantage will provide all of your Medicare benefits and services, including prescription drug coverage (Medicare Parts A, B, and D). Review the Summary of Benefits and Schedule of Copayments, attend a seminar, or call our office to talk to one of our experienced representatives to learn more.

Due to COVID-19, Capital Health Plan has pre-recorded the Retiree Advantage (HMO) seminar for your convenience.

The 2024 Retiree Advantage Annual Notice of Changes (ANOC) provides details of changed in plan benefits and coverage from one year to the next.

      The Retiree Advantage Summary of Benefits provides a summary of your plan’s benefits, premium, copayments, and coinsurance information.

          A formulary is a list of covered drugs believed to be a necessary part of a quality treatment program. The CHP Retiree Advantage Formulary was selected by CHP in consultation with a team of health care providers. You can also use our online formulary search tool.

          Your 2024 CHP Retiree Advantage (HMO) Evidence of Coverage provides details about your Medicare health and prescription drug coverage, explains how to get the care you need, and includes plan conditions and limitations.

              Sometimes you are taking a drug that is not on our formulary, and if that is the circumstance please review the Medicare Transition Policy for additional information. During the time when you are receiving a temporary supply of a drug, you should talk with your provider to decide what to do when your temporary supply runs out. You can either switch to a different drug covered by the plan or ask the plan to make an exception for you and cover your current drug. For a temporary supply, please call CHP Member Services.

                  To enroll in CHP Retiree Advantage, you will need to download and complete the CHP Retiree Advantage Enrollment Application. Please return the completed enrollment application to your employer or former employer’s benefits department, unless you are with the State of Florida. State of Florida retirees should send their enrollment application directly to Capital Health Plan.

                  Enroll anytime within 90 days before the effective date.

                    You may be able to receive assistance in the form of Medicare's Extra Help Program to pay for your prescription drug premiums and costs. The amount of Extra Help that you can get depends on your income and resources. If you qualify, you will get help paying for your Medicare drug plan's monthly premium and prescription copayments or coinsurance. Your premium generally will be lower if you receive Extra Help from Medicare.

                    You can qualify if you are eligible for Medicaid as well as Medicare. You also may qualify if your yearly income is $21,870 or less if you are single with no dependents, or $29,580 or less if you are married and living with your spouse with no dependents, and your resources are less than $16,660 if single or $33,240 if you are married and living with your spouse. If you live in Alaska or Hawaii, or pay at least half of the living expenses of dependent family members, income limits are higher.

                    An advanced directive ensures that both medical professionals and your loved ones understand the end-of-life decisions you want in the event you’re unable to explain them due to a medical emergency. An advanced directive is simply a statement, made while you are competent, about the medical treatment you want if you can’t make those decisions later. Decisions made early and communicated plainly may have tremendous value for you and your family.

                    To obtain a copy of Five Wishes, an advanced directive document that addresses all of an individual's needs (medical, personal, emotional, and spiritual), call Capital Health Plan's Health Information Line at (850) 383-3400.

                    Through the Planning Early About Care at the End (PEACE) program, Big Bend Hospice offers individualized assistance in completing the Five Wishes Advanced Directive. To schedule an appointment with a PEACE facilitator, contact Big Bend Hospice at (850) 878-5310 or visit the Big Bend Hospice website.

                    Privacy Notice - We believe our members have the right to privacy and that their nonpublic personal, financial, and health information should be kept confidential.

                    Capital Health Plan makes health care decisions to ensure quality treatment and efficient use of resources. View more information about utilization management.